MANAGEMENT OF STROKE

Nurdjaman Nurimaba dr,Sp.S(K) Neurological Department Medical Faculty Padjadjaran University Bandung
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1. Laboratory Examination

Blood : - Hematocrit, Hb, Leucocyte, Erythrocyte. (Polycytemia Vera, anemia) - Ureum, creatinine, uric acid. (Renal impairment function) - Cholesterol, triglyceride, LDL, HDL. (Dislipidemia) - Glucose (fasting & post prandial : 2 hours) (Diabetic Mellitus)
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SGOT, SGPT. (Liver Function) - Electrolytes (Ca, K, Na, Cl) Thorax Photo (Left Ventricular Hypertrophy, Pulmonary edema) ECG (LVH, Myocardial Infarction, Atrial Fibrillation) Ultra Sonography Determine stenosis of a. carotid 3

Angiography Carotid system and Vertebrobasilar system. Computed Tomography Scanning Hemispheric Lesion (Infarction : Hypodens, Haemorrhage : Hyperdens) Magnetic Resonance Imaging Determine Brainstem Lesion ( Very sensitive) Lumbal Puncture (If unavailable CT Scan and MRI)

2. Treatment
Check

airway : important for oxygenation Cardiovascular system : maintenance CBF Dont disturbed Blood pressure <200/120 mmHg (Hypertension reactive in acute phase)
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 Water

and electrolyte balance : Infuse with isotonic water haemodilution, maintenance input, food and drink, Diet basal metabolism 1500 cal.(approximate 23 cal/kg/weight) If need with NGT. Control output Present brain edema(impending herniation, herniation : control with antiedema (manitol 20 %), usually give for 5 days, rebound phenomen 6 prohibition

 Sign

of impending herniation : - Decrease of conciousnes - Pupil myosis and reactive - Cheynes stokes respiration - Bilateral Babinski (Pathologic Reflex) Sign of Herniation : - Decrease of conciousnes - Pupil anisocor - Cheynes stokes respiration - Bilateral Babinski
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 Manitol

Contraindication : - Hipotension - Renal Impairment - Dehydration - Decompensatio Cordis Head elevation 300 Hyperglycemia : if > 250 mg% give antidiabetica Control Complication and Underlying disease
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 Control Passive

Vegetative function.

Physiotherapy as soon as possible, for preventing contracture, thrombophlebitis (Deep Vein Thrombosis) Physiotherapy if complication disappear
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Active

 Drugs

: For secondary prevention Atherothrombotic Infarction - Antiplatelet agent a.Asetilosalysilic acid (inhibition cyclooxygenation enzyme) can cause tromboxan A2 decrease, Inhibit platelet agregation dose : variation, in Hasan Sadikin Hospital 250 mg/days
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 b.Pentoxyfilin

400 mg, twice daily inhibition cAmp c.Ticlopidin and Copidogrel (expensive) Prevention Cardioembolic Infarction - Anticoagulant : first with heparin intravenous, continuosly with oral anticoagulant (Coumarin)
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 Recanalization

thrombosis : - In atherothrombotic infarction RTPa, Streptokinase. Complication : bleeding Inhibition Vasospasme : Vasospasme (subarachnoid bleeding complication) - Found 2 - 3 days after onset - Clinically become worse, maybe decrease of conciousnes, neurological deficit

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 Vasospasme

mechanism : cause by accumulation prostaglandin and cathecolamin. Prohibition Vasospasme : - Give Ca antagonist before 3 days onset ( Nimodipin )

HATUR NUHUN
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